OBJECTIVES The objective of this study was to determine the cost effectiveness of paricalcitol versus standard treatment in patients with chronic kidney disease (CKD) in the health care setting in Italy, Portugal and Turkey in 2008. METHODS A Markov process model was developed employing data sources from the published literature, paricalcitol clinical trials, official country price/tariff lists and national population statistics. The comparator was the standard treatment for each country; Italy, Portugal, and Turkey. The primary perspective of the study was that of the society. The primary efficacy outcome in the Paricalcitol (reduction SHPT, reduction proteinuria, complications and mortality) were extrapolated to effectiveness outcomes: number of life years gained (LYG) and number of quality-adjusted life-years (QALYs). Clinical and economic outcomes were discounted at 3.0%. RESULTS The base case analysis is based on a 10-years time horizon and a comparison of paricalcitol in stage CKD 3, CKD 4 and CKD 5 versus standard treatment. The use of paricalcitol leads to an additional medical cost of €4335 to €6564; and an increase in life years gained of 0.48 to 0.67 years, and a gain in QALYs of 0.42 to 0.64. Consequently the use of paricalcitol results in an ICER of less than €11,000/QALY from the perspective of the society in all three countries. This value is well below the willingness to pay threshold. CONCLUSIONS The results showed that the favorable clinical benefit of paricalcitol results in positive short and long-term health economic benefits. This study suggests that the use of paricalcitol in patients with early chronic kidney disease may be cost-effective from a society perspective in Italy, Portugal and Turkey.